Background: People over age 50-55 have historically been excluded from randomized clinical trials for multiple sclerosis (MS). However, more than half of those living with an MS diagnosis are over 55.
Objective: Explore the unique considerations of treating older people with MS (PwMS) using an iterative and structured Delphi-based assessment to gather expert opinions.
Methods: Eight MS neurologists with an interest in older PwMS developed a 2-round survey. Survey respondents were qualified neurologists with ≥3 years' experience, personally responsible for treatment decisions, and treating ≥20 patients per month, of whom ≥10% were ≥50 years old. Consensus was defined as ≥75% agreement on questions with categorical responses or as a mean score ≥4 on questions with numerical responses.
Results: In Survey 1, 224 neurologists responded; 180 of these completed Survey 2. Limited consensus was reached with varying levels of agreement on several topics including identification and assessment of older patients; factors relating to treatment decisions including immunosenescence and comorbidities; considerations for high-efficacy treatments; de-escalation or discontinuation of treatment; effects of COVID-19; and unmet needs for treating this population.
Conclusion: The results of this Delphi process highlight the need for targeted studies to create guidance for the care of older PwMS.
Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Hayrettin Tumani has participated in meetings sponsored by or received honoraria for acting as an advisor/speaker for Alexion, Bayer, Biogen, Bristol-Myers Squibb, Celgene, Diamed, Fresenius, Fujirebio, GlaxoSmithKline, Horizon, Janssen-Cilag, Merck, Novartis, Roche, Sanofi-Genzyme, Siemens, and Teva. Patricia K. Coyle is an advisor or consultant for Accordant, Biogen, Bristol Myers Squibb, GlaxoSmithKline, Horizon Therapeutics, LabCorp, Eli Lilly and Company, Mylan, Novartis, Sanofi-Genzyme, and TG Therapeutics; and received grants for clinical research from Actelion (Janssen/J&J), Alkermes, Celgene, CorEvitas LLC, MedDay, NINDS, Novartis, and Roche/Genentech. Claudia Cárcamo received academic travel support from Biogen, Genzyme, Merck, Novartis, and Roche; has been a member of advisory boards at Biogen, Genzyme, Merck, and Novartis; has received principal investigator (PI) fees from the ISS “Social Cognition in MS” project at Teva, and PI fees from project CORFO 14PIE-26946—InnoBioscience SpA. Cinzia Cordioli has received grants or contracts from Biogen, Celgene, Roche, Merck Serono, and Novartis; and received consulting fees from Biogen. Pablo A. López has received personal compensation for consulting, serving on scientific advisory boards, speaking, or other activities with Biogen, Merck, Novartis, Raffo, Roche, Sanofi-Genzyme, and Teva. Marek Peterka has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Janssen-Cilag, Merck, Novartis, Roche, Sanofi-Genzyme, and Teva. Cristina Ramo-Tello has received honoraria, travel expenses, and speaker fees or advisory fees from Almirall, Biogen, Bristol, Merck, Novartis, Roche, Sandoz, and Sanofi. María I Zuluaga has received compensation for consulting services from BIIB Colombia, Merck Serono, Novartis, Roche, and Sanofi. Thijs Koster was an employee of Biogen at the time of this study and may own stock in the company. Megan Vignos is an employee of Biogen and owns stock in the company.
(© The Author(s), 2023.)